1/79. Streptococcal keratitis after myopic laser in situ keratomileusis.A 24-year-old healthy male underwent uncomplicated laser in situ keratomileusis (LASIK) in left eye. One day after the surgery, he complained of ocular pain and multiple corneal stromal infiltrates had developed in left eye. Immediately, the corneal interface and stromal bed were cleared, and maximal antibiotic treatments with fortified tobramycin (1.2%) and cefazolin (5%) were given topically. The causative organism was identified as 'Streptococcus viridans' both on smear and culture. Two days after antibiotic therapy was initiated, the ocular inflammation and corneal infiltrates had regressed and ocular pain was relieved. One month later, the patient's best corrected visual acuity had returned to 20/20 with -0.75 -1.00 x 10 degrees, however minimal stromal scarring still remained. This case demonstrates that microbial keratitis after LASIK, if treated promptly, does not lead to a permanent reduction in visual acuity.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
2/79. culture-negative ulcerative keratitis after laser in situ keratomileusis.A 40-year old man, highly myopic in both eyes, had laser in situ keratomileusis (LASIK) in the left eye in November 1996. Corneal melting and ulceration and fine striae-like interface infiltrates were noticed 1 day postoperatively. There was no response to intensive topical antibiotics in the form of hourly ofloxacin 3% (Tarivid), and satellite lesions developed on day 4. Corneal scrapings for gram stain and culture were done twice. No bacterial or fungal organisms were identified. Intensive topical fortified vancomycin (50 mg/mL) was added, and the lesions resolved gradually over the ensuing 2 weeks. Eighteen months after LASIK, refraction was -1.50 - 0.75 x 105 in the left eye, and uncorrected visual acuity was 20/70, correctable to 20/25 with spectacles.- - - - - - - - - - ranking = 0.80078946156191keywords = keratitis, ulcer (Clic here for more details about this article) |
3/79. Interface fluid associated with diffuse lamellar keratitis and epithelial ingrowth after laser in situ keratomileusis.We report a case in which diffuse interface keratitis began 1 week after bilateral uneventful laser in situ keratomileusis (LASIK). A layer of fluid in the interface with epithelial ingrowth was noted in the left eye 20 days postoperatively. The same complication occurred in the right eye 5 months after LASIK. Dry-eye syndrome and steroid-induced intraocular pressure elevation occurred in this patient with pre-existing ocular hypertension. A long course of interface inflammation was resistant to topical steroids. Surgical removal of the epithelial ingrowth and drainage of the fluid, combined with medical treatment, resulted in resolution of the inflammation. The cytopathologic examination of the fluid showed epithelial cells without signs of inflammation. The clinical features of this case represent a new complication of LASIK.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
4/79. Sterile interface keratitis associated with micropannus hemorrhage after laser in situ keratomileusis.Numerous etiologies have been suspected to lead to sterile interface keratitis after laser in situ keratomileusis. This tan interface haze with a rippled appearance has been called Sands of the Sahara. We present 2 cases in which red blood cells entered the interface after a small hemorrhage from peripheral corneal vascularization during the microkeratome pass. Although this bleeding was controlled and all visible blood cells were removed at surgery, both patients developed the appearance of a focal interface keratitis on the first postoperative day.- - - - - - - - - - ranking = 1.2keywords = keratitis (Clic here for more details about this article) |
5/79. Phototherapeutic keratectomy of a corneal scar due to presumed infection after photorefractive keratectomy.This case involves a 25-year-old patient who suffered from corneal ulceration several days after photorefractive keratectomy (PRK). A central scar developed, resulting in discomfort and reduction in visual acuity. Four months later, the scar was treated by phototherapeutic keratectomy (PTK) (25 microns depth, 5 mm ablation zone). Some scar tissue was left, but it cleared slowly and steadily over the next few years. The induced hyperopia decreased from 5.00 to 1.37 diopters spherical equivalent within 28 months postoperatively. Best corrected visual acuity increased from 20/60 preoperatively to 20/20 at 28 months postoperatively. Surgeons can encourage patients with postinfectious scars after PRK to try at least 1 PTK treatment.- - - - - - - - - - ranking = 0.10363490020441keywords = corneal ulcer, ulcer (Clic here for more details about this article) |
6/79. Diffuse interface keratitis after laser in situ keratomileusis (LASIK): a nonspecific syndrome.PURPOSE: To characterize the presentation of diffuse interface keratitis after laser in-situ keratomileusis (LASIK). methods: Case report. RESULTS: Diffuse interface keratitis occurred in the left eye of a postoperative LASIK patient after central epithelial debridement without exposure of the flap margin or elevation of the flap. CONCLUSION: Diffuse interface keratitis is a nonspecific presentation of corneal inflammation after LASIK, with accumulation of inflammatory cells in the potential space of the interface. Diffuse interface keratitis after LASIK may have multiple causes.- - - - - - - - - - ranking = 1.6keywords = keratitis (Clic here for more details about this article) |
7/79. mycobacterium chelonae keratitis after laser in situ keratomileusis successfully treated with medical therapy and flap removal.PURPOSE: To report a case of mycobacterium chelonae keratitis after laser in situ keratomileusis successfully treated with medical therapy and flap removal. methods: Case report. A 36-year-old white woman in good health developed a paracentral keratitis in her right eye 1 month after bilateral laser in situ keratomileusis. Initial treatment included topical steroids and then intensive Ocuflox (ofloxacin ophthalmic solution; Allergan, Inc, Irvine, california) without success. Cultures were negative. The keratitis worsened, and she was referred to our institution. Interface infiltration was noted, and the flap was lifted to obtain adequate laboratory studies. Cultures were positive for M chelonae. RESULTS: The keratitis was treated with intensive topical amikacin sulfate 1%, topical clarithromycin 1%, and Ciloxan (ciprofloxacin HCL; Alcon laboratories, Inc, Fort Worth, texas) with minimal improvement in her clinical condition. She developed a toxic reaction to amikacin 1%. In order to improve antibiotic penetration, the hazy, ulcerated corneal flap was removed. The keratitis then resolved with intensive topical clarithromycin 1% and Ocuflox over 5 weeks. The patient now has visual acuity without correction of 20/50, despite superficial corneal haze. CONCLUSION: M chelonae is a rare and insidious cause of infection after laser in situ keratomileusis. diagnosis can be difficult and is often delayed. Aggressive medical management, with flap removal, if needed, may lead to resolution of infection.- - - - - - - - - - ranking = 1.8001578923124keywords = keratitis, ulcer (Clic here for more details about this article) |
8/79. Pneumococcal keratitis after laser in situ keratomileusis.A 20-year-old man developed keratitis in his right eye 2 days after laser in situ keratomileusis (LASIK). The patient had rubbed the eye with unclean fingers the night before the onset of symptoms. Examination showed an inferior corneal ulcer with dense infiltration at the junction of the lamellar flap and the surrounding cornea associated with a hypopyon. streptococcus pneumoniae was isolated on culture. The ulcer resolved with combination therapy of cephazolin 5% and tobramycin 1.3% eyedrops. patients having LASIK should be instructed that inadequate patient hygiene may predispose to bacterial keratitis.- - - - - - - - - - ranking = 1.3037927925168keywords = keratitis, corneal ulcer, ulcer (Clic here for more details about this article) |
9/79. Fungal keratitis after laser in situ keratomileusis: a case report.PURPOSE: To report a case of fungal keratitis resulting after laser in situ keratomileusis (LASIK). methods: A 38-year-old white man in good health developed a corneal infiltrate with laboratory confirmation of fungal keratitis after LASIK. Corneal scrapings were taken. silver stain was positive for hyphae. culture was positive for Curvularia sp. The patient was started on intensive natamycin 5% and amphotericin 0.15% topical therapy. RESULTS: The patient's keratitis was successfully treated with intensive antifungal therapy. CONCLUSIONS: Infectious keratitis is a rare but a serious potential complication after LASIK. To our knowledge, no previous case of fungal keratitis after LASIK has been reported. This case emphasizes the importance of surveillance for infection after LASIK.- - - - - - - - - - ranking = 1.8keywords = keratitis (Clic here for more details about this article) |
10/79. Mycobacterium keratitis after laser in situ keratomileusis.PURPOSE: The authors report two cases of Mycobacterium keratitis following LASIK. methods: The case reports are based on a retrospective review of clinical history and associated findings. RESULTS: Two patients developed infectious keratitis after undergoing laser in situ keratomileusis (LASIK). In case #1, the infection developed after manipulation of the lamellar flap to remove epithelium from the stromal bed. In case #2, prior radial keratotomy may have been a contributing factor to development of the infection. Corneal infiltrates appeared as focal, white, stromal deposits. Cultures isolated mycobacterium fortuitum from case #1 and mycobacterium chelonae from case #2. Topical fortified amikacin, clarithromycin, tobramycin, and ciprofloxacin eventually controlled the infection. Topical prednisolone acetate and bandage contact lenses were necessary to control inflammation and pain. Infiltrates were slow to resolve until focal necrosis eroded through the flaps leading to rapid clearing of the infiltrates; however, scarring of the cornea developed at the site of necrosis. Visual recovery was good in the first case but limited in the second. CONCLUSIONS: Mycobacterium keratitis complicating LASIK may be difficult to eradicate until the sequestered stromal infiltrate drains. Rapid recognition of the causative organism and aggressive medical and surgical management of the infection may improve the outcome.- - - - - - - - - - ranking = 1.4keywords = keratitis (Clic here for more details about this article) |
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